Vitamin D Deficiency Is Associated with High Blood Pressure in 24-h Ambulatory Blood Pressure Monitoring in Patients with Type 2 Diabetes

Presentation Number: MON 640
Date of Presentation: April 3rd, 2017

Luiza Ferreira Sperb*1, Tatiana Pedroso de Paula1, Juliano SR Moreira2, Mauren Minuzzo de Freitas3, Maria Elisa Peinado Miller2, Andressa Siqueira da Silva2, Luciana Vercoza Viana4 and Mirela J Azevedo5
1Hospital de Clinicas de Porto Alegre, PORTO ALEGRE, Brazil, 2Hospital de Clinicas de Porto Alegre, 3Hospital de Clinicas de Proto Alegre, 4HCPA - Hospital de Clinicas de Porto Alegre, PORTO ALEGRE, 5Hospital de Clinicas de Porto Alegre, Brazil

Abstract

Background: Plasma vitamin D measurements are negatively correlated with BMI and blood pressure (BP) in general population (1,2). Since most patients with type 2 diabetes (DM2) are obese and hypertensive, it is relevant to identify vitamin D status in this population. The aim of this study was to evaluate factors associated with vitamin D deficiency [25(OH)D<20 ng/ml] in patients with DM2 and hypertension.

Methods: In this cross-sectional study BP was assessed by office measurements (Omron HEM-705CP) and 24h ambulatory blood pressure monitoring (ABPM) - Spacelabs®. Physical activity was evaluated by steps count (pedometer – Yamax Digi-Walker®). Clinical, nutritional, and laboratory parameters were evaluated by a standardized protocol. Body composition was determinated by DXA-Lunar®. Exclusion criteria were: use of vitamin supplements, serum creatinine >2.0 mg/dl, BMI >40 kg/m2, gastrointestinal diseases associated with malabsorption.

Results: A total of 116 patients (age 65±8.9 years; 43% males; BMI 30.3±4.1 kg/m², diabetes duration 12.3±8.3 years; HbA1c 7.6±1.4%) were included. Mean 25(OH)D was 20.1±9.1 ng/ml and 43% of patients were considered as deficients. Office systolic and diastolic BP were 150.7±20.9 and 83.5±11.0 mmHg, respectively. At ABPM, patients with hypovitaminosis D had higher systolic BP in 24h (135.7±10.2 vs 130.2±13.3 mmHg; P=0.016) and during daytime (138.1±11.3 vs 132.8±13.4 mmHg; P=0.026) than sufficient patients. Patients with vitamin D deficiency had also lower steps count [4350.0 (2647.8-6598.0) vs 6390.6 (4706.9-8081.1) steps/day] and urinary calcium [47.0 (32.0-141.2) vs 89.5 (67.7-152.5) mEq/24h) than sufficient patients. Regarding to dietary intake, patients with hypovitaminosis D consumed less milk (35.6 vs 64.4%; p =0.009) and less fish (31.2 vs 68.8%; p<0.001) than non-deficient patients. In multivariate logistic regression, steps count <5600 steps/day (OR=2.9, CI95% 1.1-7.6) and no milk (OR=3.9 IC95% 1.3–11.9) and no fish consumption (OR=3.4 IC95% 1.4–10.8), remained associated to vitamin D deficiency; fat mass was not associated with vitamin D deficiency.

Conclusion: Hypovitaminosis D is highly prevalent in patients with type 2 diabetes and hypertension. In this group of patients, vitamin D deficiency was associated with higher BP levels in 24h and daytime ABPM. In addition, less physical activity, milk and fish intakes were also associated with vitamin D deficiency.

 

Nothing to Disclose: LFS, TPD, JSM, MMDF, MEPM, ASD, LVV, MJA